Effect of FRAXplus adjustments on fracture risk reclassification in older Swedish women—results from the SUPERB-study
Authors' conclusion
FRAXplus improved risk stratification, with a significant proportion of older Swedish women having their fracture probabilities uplifted above the IT, more accurately reflecting their elevated fracture risk, thereby enhancing the utility of risk assessment tools and improving patient management.
Study context
- Population
- Swedish women aged 75 to 80 years, SUPERB cohortSUPERB cohort
- Participants
- 3,028 women
- Exposure
- FRAXplus-adjusted vs unadjusted FRAX 10-year major osteoporotic fracture (MOF) probability at an intervention threshold ≥ 26%
- Below intervention threshold (IT) with FRAX and FRAXplusn = 1,785
- Uplifted above IT by FRAXplusn = 339
- Above IT with FRAX and FRAXplusn = 904
- Outcome
- Proportion eligible for treatment at a MOF probability IT ≥ 26% after FRAXplus adjustments; reclassification (NRI) against incident X-ray-verified MOFs
- Follow-up
- 8 years
Methodological detailspopulation-based cohort, net reclassification improvement analysis, FRAXplus adjustments applied one factor at a time; if multiple available, the most influential factor was used
- Population-based cohort
- Net reclassification improvement analysis
- FRAXplus adjustments applied one factor at a time; if multiple available, the most influential factor was used
Main finding
As reported in the abstract
Fracture risk reclassification with FRAXplus adjustment (MOF probability, IT ≥ 26%)
- Proportion with 10-year MOF probability adjusted upwards
- 90% (n = 2723)
- Mean (± SD) change in 10-year MOF probability
- 4.25% (5.12%)
- Remained below the IT; incident MOFs
- 1785; 365 (20.4%)
- Uplifted above the IT using FRAXplus; incident MOFs
- 339; 119 (35.1%)
- Above the IT with both FRAX and FRAXplus; incident MOFs
- 904; 324 (35.8%)
- Net reclassification improvement (NRI)
- 4.82% (95% CI: 1.87-7.77%; p < 0.01)
Observational data: associations, not effects.
Further findings
10-year MOF probability adjusted upwards by FRAXplus
- Women with upward adjustment, n = 2723
- 90%
- Mean (± SD) change in MOF probability
- 4.25% (5.12%)
- Adjustment by HAL
- 31%
- Adjustment by trabecular bone score (TBS)
- 23%
- Adjustment by falls
- 20%
- Adjustment by lumbar spine (LS) bone mineral density (BMD)
- 8%
- Adjustment by recent fracture
- 5%
- Hip fracture probabilities: similar patterns
Original publication
Effect of FRAXplus adjustments on fracture risk reclassification in older Swedish women—results from the SUPERB-study. Osteoporos Int. Published 11 July 2025. doi:10.
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